Nutritional Therapy Ups Liver Function in Minimal Hepatic Encephalopathy
SAN FRANCISCO, CA—In patients with minimal hepatic encephalopathy, nutritional therapy is effective and improves HRQOL, a randomized controlled trial presented during The Liver Meeting® 2015 has reported.
Barjesh Chander Sharma, Professor of the Department of Gastroenterology, G. B. Pant Institute of Postgraduate Medical Education and Research in New Delhi, India, and colleagues assessed the effects of nutritional therapy on cognitive function and HRQOL in 120 patients with cirrhosis being treated in a tertiary care setting. The patients had minimal hepatic encephalopathy, which is predictive for overt hepatic encephalopathy and is associated with poor prognosis, they explained.
“Minimal hepatic encephalopathy was diagnosed based on psychometry hepatic encephalopathy score (PHES),” Dr. Sharma noted, while “HRQOL was assessed by sickness impact profile (SIP) questionnaire.” The primary study endpoints were improvement or worsening in minimal hepatic encephalopathy and improvement in HRQOL.
The patients were randomly assigned to nutritional therapy, 30–35kcal/kg/day and 1.0–1.5g of vegetable protein/kg/day (n=60) or no nutritional therapy, defined as no dietary intervention (n=60) for 6 months.
In the nutritional therapy group, age was 42.1 ± 10.3 years and 48 were men; in the no therapy group, age was 42.4 ± 9.6 years and 47 were men. No significant differences in baseline characteristics were observed between the two groups, including in PHES (-8.12 ± 1.32 vs. -8.53 ± 1.38; P=0.08) or SIP scores.
Study results showed that reversal of minimal hepatic encephalopathy was higher in the group assigned to nutritional therapy compared with the no dietary intervention group, 71.1% vs. 22.8%, respectively (P=0.001).
Patients who received nutritional therapy also showed improvement in PHES (Δ 3.86 ± 3.54 vs. 0.52 ± 4.09; P=0.001) and HRQOL (Δ Total SIP 5.87 ± 2.79 vs. 1.25 ± 3.81; P<0.001) compared with no dietary intervention.
There were less hospitalizations reported in the nutritional therapy group vs. no dietary intervention group (8 vs.16; P<0.03) and less deaths (5 vs. 9; P=0.12). More than improvements in nutritional status, dietary intervention in patients with cirrhosis with MHE led to improved "cognitive functions, HRQOL, liver functions, and decreased hospitalization," concluded Dr. Sharma.